Penny Simkin has mixed feelings about current, mainstream trends in birth. "Well, I'm more hopeful now than I was five years ago," she says, referring to the growing doula movement, and also her work with others in the field who have come together as the Coalition for Improving Maternity Services (CIMS).

Out of growing concern over the kind of care mothers and babies typically receive in this country, CIMS formed a few years ago to produce a document called The Mother Friendly Childbirth Initiative, which they hope will be adopted by hospitals and birth centers nationwide. The initiative defines mother-friendly maternity services as those which promote birth as a normal process; empower women and provide them the freedom to make informed choices; do no harm by applying unnecessary interventions; and take responsibility for quality of care. It also outlines 10 important steps for hospitals, birth centers and home birth services to take to become mother-friendly.

As chair of CIMS's education committee, Simkin hopes to drum up as much publicity for the Mother Friendly Childbirth Initiative as possible.

"It's time to give mothers the kind of care they need. So we're hoping this is a groundswell. There are many wonderful people involved in the effort to revolutionize maternity care in the US, so I feel hopeful -- even though most women don't have a lot of confidence in their own ability to give birth and many don't see why they should bother to do it themselves. Through better education of both care providers and of the public, through nurturing, support, and humane care during childbirth, and through the application of scientific findings on safety in childbirth, women will gain confidence. This [initiative] is based on scientific research which proves the effectiveness of mother-friendly care. It also saves money and is safe. So I think we may be able to get another philosophy of care prevailing in this country."

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